Pilot study evaluating the monitoring of canine diabetes mellitus in primary care practice

Abstract

ObjectivesThis study aimed to describe how canine diabetes mellitus (CDM) is monitored in primary care practice (PCP) and to report outcomes.DesignRetrospective case review.SettingPCP.Participants40 dogs of 22 different pedigrees and five crossbreeds. Median age at diagnosis was nine years and six months (eight years six months to 10 years five months). Dogs were diagnosed with CDM between January 1, 2008 and December 30, 2012 and remained with the practice to the study end or until death.Primary and secondary outcome measuresStability achievement and death or euthanasia. Consultations for each dog were identified and recorded through records collected from the PCP (January 1, 2008 to December 30, 2012).ResultsA median of three consultations per dog occurred in the first month, subsequently falling to a median of one consultation every 19 days thereafter. After the first month postdiagnosis, weight and single blood glucose concentrations were most frequently recorded at 66.8 and 42 per cent of consultations respectively and a blood glucose curve was performed infrequently (17.4 per cent). Serum biochemistry was measured at 8 per cent of consultations and urine culture at only 0.8 per cent. Median survival time (MST) for all dogs was eight months (2–21 months). Eighteen dogs stabilised within three months of diagnosis and their MST was 20.5 months, (10.25–25.75 months), significantly longer than the 22 dogs not achieving stability within three months (MST 2.5 months, 0–5.5 months) (P<0.001). Those dogs not surviving beyond the first month had significantly fewer consultations than those still alive (P<0.005).ConclusionsThis pilot study indicates dogs with CDM managed solely in PCP experience limited monitoring tests and have lower MST than reported in the literature. Recruitment of a larger cohort of CDM cases from a larger number of PCP will help determine whether these results accurately represent this demographic and verify if infrequent testing is associated with a poor outcome. Importantly, prospective evaluation of decision-making around monitoring CDM in PCP is required, to help determine the effectiveness and feasibility of more frequent monitoring strategies, such as those recommended by the American Animal Hospital Association, particularly to influence MST.

Clinical utility of serum fructosamine in long‐term monitoring of diabetes mellitus in dogs

“…Clinical control of DM is achieved in 55% of diabetic dogs treated in primary care practices, where clinical signs are typically the sole monitoring tool, and is achieved more frequently when the number and frequency of follow-up visits are higher, 19 in agreement with the current findings. However, as uncontrolled DM reportedly leads to death or euthanasia and relatively short median survival time, 19 further optimisation of both monitoring and treatment of dogs with uncontrolled DM is needed. Dogs in the current cohort were mostly considered to have difficult to regulate DM due to their high prevalence of chronic concomitant diseases, and because they were referred to a tertiary care facility by their primary care veterinarians.…”

“…While the exact contribution of the clinical signs and sFA to treatment decisions cannot be retrospectively quantified in this study, this finding suggests that use of sFA did contribute to the overall improvement in control of DM, and this became evident with accumulative follow-up visits. Clinical control of DM is achieved in 55% of diabetic dogs treated in primary care practices, where clinical signs are typically the sole monitoring tool, and is achieved more frequently when the number and frequency of follow-up visits are higher, 19 in agreement with the current findings. However, as uncontrolled DM reportedly leads to death or euthanasia and relatively short median survival time, 19 further optimisation of both monitoring and treatment of dogs with uncontrolled DM is needed.…”

“…1,18 Nevertheless, clinical assessment heavily relies on the owners' subjective evaluation, which may contribute to inaccurate assessment of glycaemic control. 17,19 Therefore, clinical assessment should preferably be supported by objective evaluation tools (e.g., sFA, HbA1c and CGMS-generated data). 1,5,15,20 However, interpretation of data generated by these tools may not always be simple, due to their inherent limitations and potentially contradicting findings compared to the observed clinical signs.…”

Evaluation of fructosamine concentration as an index marker for glycaemic control in diabetic dogs

“…Only +LRs > 10 produce substantial changes in post-test probability. 25 Although fructosamine is commonly used in clinical trials 11,12,[26][27][28][29][30][31] and primary care practice to monitor canine DM, 32 studies confirming its diagnostic efficacy in assessing long-term glycaemic control are scarce. In the absence of published data, commercial laboratories and scientists currently adopt cutoffs for differentiation of various degrees of diabetic control from specialist textbooks and review articles.…”

Flash glucose monitoring in diabetic dogs: a feasible method for evaluating glycemic control

“…Unfortunately, many owners are unwilling or unable to take capillary blood samples [3] and monitoring is reduced to "spot check" glucose measurements at home or in-clinic measurements. Alarmingly, a recent pilot study, evaluating the monitoring of canine DM in primary care practice in the United Kingdom demonstrated that single blood glucose determinations are performed in less than 50 % of veterinary consultations and home glucose monitoring is the exception [4]. Whether this applies to other countries has not been investigated.…”